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Alla D, Shah DJ, Seepana M, Salian RB, Alla SSM, Krishna Mohanan M, Sabıroğlu M, Vegesna MSS, Singh A, Gupta S, Shivalingappa Rekha S. Safety of Proton Pump Inhibitors in Pediatric Population: A Systematic Review. Glob Pediatr Health 2024; 11:2333794X241248967. [PMID: 38685999 PMCID: PMC11057350 DOI: 10.1177/2333794x241248967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/27/2024] [Accepted: 04/05/2024] [Indexed: 05/02/2024] Open
Abstract
Objective. Commonly recommended drugs for adults and children include proton pump inhibitors (PPIs), proven effective for treating peptic diseases like stomach ulcers, GERD, and Helicobacter pylori infections in children over 1-year-old. Yet, prolonged PPI use carries higher risks of adverse reactions, prompting this study's analysis. Methods. We have performed a systematic review of 30 articles, which include a total of 762 505 pediatric patients. Results. Adverse effects were encountered in 6.98% of the population. The 5 most common adverse effects were respiratory tract complications, gastrointestinal complications, urinary tract infections, asthma, and ENT infections. Conclusion. Hence, PPIs should be prescribed only when necessary, and physicians should prioritize patient education when considering their use.
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Affiliation(s)
- Deekshitha Alla
- Andhra Medical College, Visakhapatnam, Andhra Pradesh, India
| | | | | | | | | | - Midhun Krishna Mohanan
- Sree Uthradom Thirunal (SUT) Academy of Medical Sciences, Thiruvananthapuram, Kerala, India
| | | | | | - Aradhya Singh
- Spartan Health Sciences University, Vieux Fort, Saint Lucia
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El-Magd ESA, Elgeidie A, Elmahdy Y, El Sorogy M, Elyamany MA, Abulazm IL, Abbas A. Impact of laparoscopic repair on type III/IV giant paraesophageal hernias: a single-center experience. Hernia 2023; 27:1555-1570. [PMID: 37642773 DOI: 10.1007/s10029-023-02851-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/14/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Giant paraesophageal hernia (GPEH) is a challenging problem for surgeons because of its high recurrence rate. This study was conducted to compare the outcomes in type IV vs. type III GPEHs after laparoscopic repair. Other outcomes included peri-operative morbidity and long-term quality of life. METHODS A retrospective analysis of 130 GPEH patients in a period between 2010 and 2019 underwent a tailored laparoscopic repair in our tertiary center with a minimum follow-up of 48 months. Operative steps included hernial sac excision, crural repair, relaxing incisions, and mesh cruroplasty with special indications. RESULTS The study enrolled 90 patients with type III and 40 patients with type IV GPEH. Type IV GPEH patients were older, more fragile, and scored worse on ASA classification, aside from having a more challenging surgical technique (wider crura, weaker muscles, increased need for release incisions, and mesh cruroplasty).Type IV GPEHs had a prolonged operative durations, and a higher conversion rate. Additionally, the same group showed increased morbidity, mortality, and re-operation rates. With a mean follow-up of 65 months (range 48-150 months), the incidence of recurrence was 20.7%, with an increased incidence in type IV GPEH (37.5% vs. 13.33% in type III GPEH). Type IV GPEH, low pre-operative albumin, larger crural defect, and low surgeon experience were significant risk factors for recurrence after laparoscopic repair of GPEH. CONCLUSION Type IV GPEH has a higher peri-operative morbidity and recurrence rate; so, a more tailored laparoscopic repair with a high surgeon experience is needed.
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Affiliation(s)
- E-S A El-Magd
- Faculty of Medicine, Mansoura University, Mansoura, Egypt.
- Department of General Surgery, Faculty of Medicine, Gastrointestinal Surgical Center GISC, Mansoura University, Gehan Street, Mansoura, 35511, Al Dakahlia Governorate, Egypt.
| | - A Elgeidie
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Y Elmahdy
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - M El Sorogy
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - M A Elyamany
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - I L Abulazm
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - A Abbas
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Dutta AK, Jain A, Jearth V, Mahajan R, Panigrahi MK, Sharma V, Goenka MK, Kochhar R, Makharia G, Reddy DN, Kirubakaran R, Ahuja V, Berry N, Bhat N, Dutta U, Ghoshal UC, Jain A, Jalihal U, Jayanthi V, Kumar A, Nijhawan S, Poddar U, Ramesh GN, Singh SP, Zargar S, Bhatia S. Guidelines on optimizing the use of proton pump inhibitors: PPI stewardship. Indian J Gastroenterol 2023; 42:601-628. [PMID: 37698821 DOI: 10.1007/s12664-023-01428-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/10/2023] [Indexed: 09/13/2023]
Abstract
Proton pump inhibitors (PPIs) have been available for over three decades and are among the most commonly prescribed medications. They are effective in treating a variety of gastric acid-related disorders. They are freely available and based on current evidence, use of PPIs for inappropriate indications and duration appears to be common. Over the years, concerns have been raised on the safety of PPIs as they have been associated with several adverse effects. Hence, there is a need for PPI stewardship to promote the use of PPIs for appropriate indication and duration. With this objective, the Indian Society of Gastroenterology has formulated guidelines on the rational use of PPIs. The guidelines were developed using a modified Delphi process. This paper presents these guidelines in detail, including the statements, review of literature, level of evidence and recommendations. This would help the clinicians in optimizing the use of PPIs in their practice and promote PPI stewardship.
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Affiliation(s)
- Amit Kumar Dutta
- Department of Gastroenterology, Christian Medical College and Hospital, Vellore, 632 004, India.
| | | | - Vaneet Jearth
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Ramit Mahajan
- Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | | | - Vishal Sharma
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | | | | | - Govind Makharia
- All India Institute of Medical Sciences, New Delhi, 110 029, India
| | | | - Richard Kirubakaran
- Center of Biostatistics and Evidence Based Medicine, Vellore, 632 004, India
| | - Vineet Ahuja
- All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Neha Berry
- BLK Institute of Digestive and Liver Disease, New Delhi, 201 012, India
| | - Naresh Bhat
- Aster CMI Hospital, Bengaluru, 560 092, India
| | - Usha Dutta
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Uday Chand Ghoshal
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Ajay Jain
- Choithram Hospital and Research Center, Indore, 452 014, India
| | | | - V Jayanthi
- Sri Ramachandra Medical College, Chennai, 600 116, India
| | - Ajay Kumar
- Institute of Digestive and Liver Diseases, BLK - Max Superspeciality Hospital, New Delhi, 201 012, India
| | | | - Ujjal Poddar
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India
| | | | - Shivram P Singh
- Kalinga Gastroenterology Foundation, Cuttack, 753 001, India
| | - Showkat Zargar
- Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Kashmir, 190 011, India
| | - Shobna Bhatia
- Sir H N Reliance Foundation Hospital, Mumbai, 400 004, India
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Tighe MP, Andrews E, Liddicoat I, Afzal NA, Hayen A, Beattie RM. Pharmacological treatment of gastro-oesophageal reflux in children. Cochrane Database Syst Rev 2023; 8:CD008550. [PMID: 37635269 PMCID: PMC10443045 DOI: 10.1002/14651858.cd008550.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
BACKGROUND Gastro-oesophageal reflux (GOR) is characterised by the regurgitation of gastric contents into the oesophagus. GOR is a common presentation in infancy, both in primary and secondary care, affecting approximately 50% of infants under three months old. The natural history of GOR in infancy is generally of a self-limiting condition that improves with age, but older children and children with co-existing medical conditions can have more protracted symptoms. The distinction between gastro-oesophageal reflux disease (GORD) and GOR is debated. Current National Institute of Health and Care Excellence (NICE) guidelines define GORD as GOR causing symptoms severe enough to merit treatment. This is an update of a review first published in 2014. OBJECTIVES To assess the effects of pharmacological treatments for GOR in infants and children. SEARCH METHODS For this update, we searched CENTRAL, MEDLINE, Embase, and Web of Science up to 17 September 2022. We also searched for ongoing trials in clinical trials registries, contacted experts in the field, and searched the reference lists of trials and reviews for any additional trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared any currently-available pharmacological treatment for GOR in children with placebo or another medication. We excluded studies assessing dietary management of GORD and studies of thickened feeds. We included studies in infants and children up to 16 years old. DATA COLLECTION AND ANALYSIS We used standard methodology expected by Cochrane. MAIN RESULTS We included 36 RCTs involving 2251 children and infants. We were able to extract summary data from 14 RCTs; the remaining trials had insufficient data for extraction. We were unable to pool results in a meta-analysis due to methodological differences in the included studies (including heterogeneous outcomes, study populations, and study design). We present the results in two groups by age: infants up to 12 months old, and children aged 12 months to 16 years old. Infants Omeprazole versus placebo: there is no clear effect on symptoms from omeprazole. One study (30 infants; very low-certainty evidence) showed cry/fuss time in infants aged three to 12 months had altered from 246 ± 105 minutes/day at baseline (mean +/- standard deviation (SD)) to 191 ± 120 minutes/day in the omeprazole group and from 287 ± 132 minutes/day to 201 ± 100 minutes/day in the placebo group (mean difference (MD) 10 minutes/day lower (95% confidence interval (CI) -89.1 to 69.1)). The reflux index changed in the omeprazole group from 9.9 ± 5.8% in 24 hours to 1.0 ± 1.3% and in the placebo group from 7.2 ± 6.0% to 5.3 ± 4.9% in 24 hours (MD 7% lower, 95% CI -4.7 to -9.3). Omeprazole versus ranitidine: one study (76 infants; very low-certainty evidence) showed omeprazole may or may not provide symptomatic benefit equivalent to ranitidine. Symptom scores in the omeprazole group changed from 51.9 ± 5.4 to 2.4 ± 1.2, and in the ranitidine group from 47 ± 5.6 to 2.5 ± 0.6 after two weeks: MD -4.97 (95% CI -7.33 to -2.61). Esomeprazole versus placebo: esomeprazole appeared to show no additional reduction in the number of GORD symptoms compared to placebo (1 study, 52 neonates; very low-certainty evidence): both the esomeprazole group (184.7 ± 78.5 to 156.7 ± 75.1) and placebo group (183.1 ± 77.5 to 158.3 ± 75.9) improved: MD -3.2 (95% CI -4.6 to -1.8). Children Proton pump inhibitors (PPIs) at different doses may provide little to no symptomatic and endoscopic benefit. Rabeprazole given at different doses (0.5 mg/kg and 1 mg/kg) may provide similar symptom improvement (127 children in total; very low-certainty evidence). In the lower-dose group (0.5 mg/kg), symptom scores improved in both a low-weight group of children (< 15 kg) (mean -10.6 ± SD 11.13) and a high-weight group of children (> 15 kg) (mean -13.6 ± 13.1). In the higher-dose groups (1 mg/kg), scores improved in the low-weight (-9 ± 11.2) and higher-weight groups (-8.3 ± 9.2). For the higher-weight group, symptom score mean difference between the two different dosing regimens was 2.3 (95% CI -2 to 6.6), and for the lower-weight group, symptom score MD was 4.6 (95% CI -2.9 to 12). Pantoprazole: pantoprazole may or may not improve symptom scores at 0.3 mg/kg, 0.6 mg/kg, and 1.2 mg/kg pantoprazole in children aged one to five years by week eight, with no difference between 0.3 mg/kg and 1.2 mg/kg dosing (0.3 mg/kg mean -2.4 ± 1.7; 1.2 mg/kg -1.7 ± 1.2: MD 0.7 (95% CI -0.4 to 1.8)) (one study, 60 children; very low-certainty evidence). There were insufficient summary data to assess other medications. AUTHORS' CONCLUSIONS There is very low-certainty evidence about symptom improvements and changes in pH indices for infants. There are no summary data for endoscopic changes. Medications may or may not provide a benefit (based on very low-certainty evidence) for infants whose symptoms remain bothersome, despite nonmedical interventions or parental reassurance. If a medication is required, there is no clear evidence based on summary data for omeprazole, esomeprazole (in neonates), H₂antagonists, and alginates for symptom improvements (very low-certainty evidence). Further studies with longer follow-up are needed. In older children with GORD, in studies with summary data extracted, there is very low-certainty evidence that PPIs (rabeprazole and pantoprazole) may or may not improve GORD outcomes. No robust data exist for other medications. Further RCT evidence is required in all areas, including subgroups (preterm babies and children with neurodisabilities).
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Affiliation(s)
- Mark P Tighe
- Department of Paediatrics, University Hospitals Dorset, Poole, UK
| | - Edward Andrews
- Department of Paediatrics, University Hospitals Dorset, Poole, UK
| | - Iona Liddicoat
- Department of Paediatrics, University Hospitals Dorset, Poole, UK
| | - Nadeem A Afzal
- Faculty of Science & Health, Portsmouth University, Portsmouth, UK
| | - Andrew Hayen
- Australian Centre for Public and Population Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - R Mark Beattie
- Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Dipasquale V, Cicala G, Spina E, Romano C. A Narrative Review on Efficacy and Safety of Proton Pump Inhibitors in Children. Front Pharmacol 2022; 13:839972. [PMID: 35222047 PMCID: PMC8866943 DOI: 10.3389/fphar.2022.839972] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/20/2022] [Indexed: 12/21/2022] Open
Abstract
Proton pump inhibitors (PPIs) are among the most prescribed drugs worldwide and include omeprazole, esomeprazole, lansoprazole, pantoprazole, and rabeprazole. Their use in pediatrics is approved for children older than 1 year, for the short-term treatment of symptomatic gastroesophageal reflux disease (GERD), healing of erosive esophagitis, treatment of peptic ulcer disease, and eradication of Helicobacter pylori. PPIs are also considered the standard of care for pediatric eosinophilic esophagitis. Despite the strict range of indications, the use of this class of molecules has increased in all pediatric age ranges. The long-term gastric acid suppression in children has been linked to increased risks of gastrointestinal and lower respiratory tract infections, bone fractures, and allergy. This study aims to provide a comprehensive overview of the mechanism of actions, use (and misuse) in infants and children, and safety of PPIs.
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Affiliation(s)
- Valeria Dipasquale
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | - Giuseppe Cicala
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
- *Correspondence: Claudio Romano,
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Diagnosis and Management of Gastroesophageal Reflux Disease in Children: Recommendations of Pediatric Gastroenterology Chapter of Indian Academy of Pediatrics, Indian Society of Pediatric Gastroenterology, Hepatology and Nutrition (ISPGHAN). Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2400-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bertolo Guariento MR, Pereira da Silva J, Guariento GB, Pinasco GC, Sales AB, Alves CBR, Pimassoni LHS, Ramos-Silva V. Children and adolescents’ health on focus: Gastrointestinal injuries associated with Helicobacter pylori. REVISTA CIÊNCIAS EM SAÚDE 2020. [DOI: 10.21876/rcshci.v10i4.1026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objective: To describe the prevalence of Helicobacter pylori (HP) in children and adolescents, and to assess its association with lesions in the esophagus, stomach, and duodenum according to the patient’s life cycle. Methodsː A cross-sectional analytical study with children and adolescents referred to a gastroenterology service and underwent esophagogastroduodenoscopy at a hospital in Vitória, Espírito Santo, Brazil, from 2001 to 2013. Variables analyzed were the following: sex, age, macro and microscopic alterations and severity of infestation. The Chi-square and Fisher's exact tests and adjusted residue analysis were used (α = 5%). Resultsː the prevalence of infection was 24.4%. Esophagitis (29.4%) and gastritis (34.1%) were associated with HP. The life cycle was associated with esophagitis and duodenitis. Infection was associated with life cycle: infants (0.8%), preschool children (10.5%), school-aged children (16.5%), and adolescents (72.2%). The residues showed a strong association between HP and gastritis, and no association between the school-aged and esophagitis. Adolescents were the major contributors to the association between life cycle and infection, and life cycle and lesion. Conclusionsː Infection with HP was associated with esophagitis and gastritis and was higher among adolescents, who had a marked tendency to develop gastritis and a milder tendency to develop esophagitis. The tendency of developing infection and gastritis was not present in the other life cycles. Public policies focusing on promotion and protecting health, especially in vulnerable population groups, are needed.
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Reflux and dental disorders in the pediatric population: A systematic review. Int J Pediatr Otorhinolaryngol 2020; 136:110166. [PMID: 32535495 DOI: 10.1016/j.ijporl.2020.110166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/30/2020] [Accepted: 05/30/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To investigate the role of laryngopharyngeal reflux (LPR) or gastroesophageal reflux disease (GERD) in the development of dental disorders in pediatric population. METHODS PubMed, Scopus Cochrane database were assessed for subject headings using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) recommendations. Relevant studies published between January 1990 and January 2020 describing the association between reflux and dental disorders in children were retrieved. Three authors reviewed the LPR diagnosis method; inclusion criteria and outcomes. The bias analysis was performed through the tools of the Oxford Centre for Evidence-Based Medicine evidence levels. RESULTS The electronic search identified 126 publications, of which 11 clinical studies and 2 basic science researches met our inclusion criteria. There is an important heterogeneity between studies about diagnostic method and clinical outcome evaluation. All studies based the reflux diagnosis on GERD criteria. No author considered hypopharyngeal nonacid reflux episodes through hypopharyngeal-esophageal intraluminal multichannel impedance pH monitoring (HEMII-pH). The results of studies support a higher prevalence of dental erosion in children with GERD compared with healthy individuals. Controversial findings were found about the potential association between reflux and caries, and the modification of both saliva composition and production in reflux children. CONCLUSION The association between reflux and dental disorder is still uncertain. Future studies considering pharyngeal acid and nonacid reflux episodes through HEMII-pH are needed to confirm this hypothesis. The pepsin detection in saliva would be an additional way for detecting LPR in children with dental disorders.
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Pasman EA, Ong B, Witmer CP, Nylund CM. Proton Pump Inhibitors in Children: the Good, the Bad, and the Ugly. Curr Allergy Asthma Rep 2020; 20:39. [PMID: 32524278 DOI: 10.1007/s11882-020-00926-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The evidence supporting or contesting the prescription of proton pump inhibitors (PPIs) for children and updates on side effects are reviewed. RECENT FINDINGS PPIs remain an important therapeutic option for esophagitis and gastritis. However, recent studies demonstrate no benefit when prescribing PPIs for chronic cough, infantile reflux, asthma, or functional gastrointestinal disorders. Recent studies suggest adverse effects on microbiome diversity and immune function, resulting in increased rates of gastrointestinal infections, bone fractures, and atopic disorders. PPIs influence a variety of cell types within the in the innate and adaptive immune systems. PPI prescriptions in children may be indicated for select conditions; however, multiple side effects and immune effects have been described. While most of these side effects are rare and mild, some studies suggest enduring adverse effects. Future studies to elucidate the mechanism behind some of these immune and infectious complications will be beneficial.
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Affiliation(s)
- Eric A Pasman
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Bruce Ong
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Allergy and Immunology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Claire P Witmer
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Cade M Nylund
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA.
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
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Safe M, Chan WH, Leach ST, Sutton L, Lui K, Krishnan U. Widespread use of gastric acid inhibitors in infants: Are they needed? Are they safe? World J Gastrointest Pharmacol Ther 2016; 7:531-539. [PMID: 27867686 PMCID: PMC5095572 DOI: 10.4292/wjgpt.v7.i4.531] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/16/2016] [Accepted: 08/06/2016] [Indexed: 02/06/2023] Open
Abstract
Gastroesophageal reflux is a common phenomenon in infants, but the differentiation between gastroesophageal reflux and gastroesophageal reflux disease can be difficult. Symptoms are non-specific and there is increasing evidence that the majority of symptoms may not be acid-related. Despite this, gastric acid inhibitors such as proton pump inhibitors are widely and increasingly used, often without objective evidence or investigations to guide treatment. Several studies have shown that these medications are ineffective at treating symptoms associated with reflux in the absence of endoscopically proven oesophagitis. With a lack of evidence for efficacy, attention is now being turned to the potential risks of gastric acid suppression. Previously assumed safety of these medications is being challenged with evidence of potential side effects including GI and respiratory infections, bacterial overgrowth, adverse bone health, food allergy and drug interactions.
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